System and method to electronically coordinate and document patient care regardless of physical setting

ABSTRACT

A system to electronically coordinate and document pattern care regardless of physical setting. The system includes a wearable subsystem attached to a patient at the point of injury and configured to remain attached to the patient at the point of injury and during one or more encounters with medical personnel or to a time the patient reaches a clinical health care facility. The wearable subsystem is configured to store patient identification information and critical health care information received via wireless communication from an end user computing device at the point of injury and is configured to store added health care information provided by medical personnel from or at the point of injury and during the one or more encounters with the medical personnel or to a time the patient reaches a clinical care facility.

RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.16/887,180 filed May 29, 2020 which claims benefit of and priority toU.S. Provisional Application Ser. No. 62/855,267 filed May 31, 2019,under 35 U.S.C. §§ 119, 120, 363, 365, and 37 C.F.R. § 1.55 and § 1.78,which is incorporated herein by this reference.

GOVERNMENT RIGHTS

This invention was made in part with U.S. Government support underContract No. W81XWH-18-C-0134, awarded by the U.S. Army Medical ResearchAcquisition Activity. The Government has certain rights in theinvention.

FIELD OF THE INVENTION

This invention relates to a system and method to electronicallycoordinate and document patient care regardless of physical setting.

BACKGROUND OF THE INVENTION

The “golden hour” is a well-studied and documented period after theonset of out-of-hospital traumatic injury wherein the chance ofmorbidity increases the longer a patient is not properly cared for.Nearly 90% of combat casualty fatalities occur prior to reaching aproperly equipped medical center, with nearly a quarter of the 4,596combat deaths in Iraq and Afghanistan between 2001 and 2011 classifiedas ‘potentially survivable’ See e.g., Eastridge, B. J., et al., Death onthe battlefield (2001-2011): Implications for the Future of CombatCasualty Care, Journal of Trauma and Acute Care Surgery, 73 (6), pp.S431-S437 (2012), incorporated by reference herein. To address theselong-standing point-of-injury trauma care issues within the battlefield.Butler, et al. developed a novel prehospital trauma management approachknown as Tactical Combat Casualty Care (TCCC). TCCC has saved countlessmilitary and civilian lives by normalizing priority driven care. Seee.g. Butler, F. K., J. Haymann, and E. G. Butler, Tactical CombatCasualty Care in Special Operations, Association of Military Surgeons ofthe U.S., 161 (suppl_1), pp. 3-16, (1996), incorporated by referenceherein. The documentation of the care delivered via this approach,currently performed by the U.S. Military on a paper TCCC Card (DD Form1380), is imperative not only to communicate patient status, injury, andtreatments to subsequent providers, but also to allow those monitoringthe TCCC approach to evaluate its efficacy in a quantitative manner.Unfortunately, less than 10% of the 30,000 casualties in Iraq andAfghanistan had any form of documentation of their combat casualty carein their medical records, substantially hindering the aforementionedprocesses, and leading to a staggering 67% of sentinel events beingattributed to an error in communication. See e.g. Butler, F. K.,Tactical Combat Casualty Care: Update 2009, Journal of Trauma and AcuteCare Surgery, 69 (1), pp. S10-S13 (2010) and Stahl, K., et al.,Enhancing Patient Safety in the Trauma/Surgical Intensive Care Unit,Journal of Trauma and Acute Care Surgery, 67 (3), p. 430-435 (2009),both incorporated by reference herein. Identifying this gap in carecoordination, the military and civilian emergency medical services havegone to great lengths to improve their electronic record keepingcapabilities, resulting in an electronic version of the TCCC card thatcan and is being implemented into end user computing devices, e.g., theArmy's NETT Warrior, the Air Forces BATDOK, and SOCOM's ATAK, as well asinto civilian EMS electronic medical record systems. However, to datethere is no known system or method to electronically coordinate anddocument patient care regardless of physical setting.

SUMMARY OF THE INVENTION

In one aspect, a system to electronically coordinate and documentpatient care regardless of physical setting is featured. The systemincludes a wearable subsystem attached to a patient at the point ofinjury and configured to remain attached to the patient at the point ofinjury and during one or more encounters with medical personnel or to atime the patient reaches a clinical health care facility. The wearablesubsystem is configured to store patient identification information andcritical health care information received via wireless communicationfrom an end user computing device at the point of injury and isconfigured to store added health care information provided by medicalpersonnel from or at the point of injury and during the one or moreencounters with the medical personnel or to a time the patient readies aclinical care facility.

In one embodiment, the wearable subsystem may be configured as anadhesive patch. The adhesive patch may include a flexible printedcircuit board. The flexible printed circuit board may include one ormore of a processing subsystem, an electronic storage device, firmware,and a power supply. The adhesive patch may include a plurality offlexible layers about the flexible printed board. One of the pluralityof flexible layers may include an adhesive layer configured to attach tothe skin of the patient. One or more of the plurality of flexible layersmay be configured to increase moisture vapor transmission rate of vaporfrom skin of the patient to provide increased breathability andattachability of the adhesive patch subsystem to the skin. The flexibleprinted circuit board may include a breathable substrate configured toincrease moisture vapor transmission rate of vapor from skin of thepatient to provide increased breathability. The flexible primed circuitboard may include a plurality of openings configured to increasemoisture vapor transmission rale of vapor from skin of the patient toprovide increased breathability. The wearable subsystem may have a smallarea. The area of the wearable subsystem may be less than about 35 cm².The power supply may include a small sized battery configured to providepower for an extended period of time. The power supply may include asupercapacitor configured to provide power for an extended period oftime. The wearable subsystem may be attached to an easily accessiblearea of the patient. The wearable subsystem may be configured totransfer the patient identification information and critical health careinformation and the health care information added by the medicalpersonnel to an electronic medical record or electronic health record.The wearable subsystem may be configured to operate regardless of astate of long distance communication. The wearable subsystem may beconfigured to operate using short range communication. The end usercomputing device may be configured to capture via wireless communicationthe patient identification information and the critical health careinformation from an electronic personal identification device alreadylocated on a patient at a point of injury. The end user computing devicemay operate using short range communication. The end user computingdevice may include one or more casualty care programs configured toinput and/or receive and store the patient identification information,and critical health care information and the health care informationprovided by the medical personnel. The one or more casualty careprograms may include an electronic Tactical Combat Casualty Care Program(TCCC). The one or more casualty care programs may include an electronicPatient Care Reporting (ePCR) subsystem.

In another aspect, a method for electronically coordinating anddocumenting patient care regardless of physical setting is featured. Themethod includes attaching a wearable subsystem to a patient at a pointof injury, the wearable subsystem configured to remain attached to thepatient at the point of injury and during one or more encounters withmedical personnel or to a time the patient reaches a clinical carefacility and storing patient identification information and criticalcare health care information received via wireless communication from anend user computing device at the point of injury on the wearablesubsystem and storing added healthcare information provided by themedical personnel from or at the point of injury and during one or moreencounters with medical personnel or to a time the patient reaches theclinical care facility.

In one embodiment, the wireless communication may include short rangecommunication. The method may further include transferring the patientidentification information and critical health care information andhealth care added by medical personnel to an electronic medical recordor an electronic health record. The method may further includeincreasing moisture transmission rate of the wearable subsystem toprovide increased breathability and attachability of the wearablesubsystem to the patient. The method may further include capturing viawireless communication the patient identification information andcritical health care information from an electronic personalcommunication device already located on the patient at the point ofinjury. The method may further include capturing via the patientidentification information and critical health care information from anelectronic personal communication device already located on the patientat the point of injury using short range communication.

The subject invention, however, in other embodiments, need not achieveall these objectives and the claims hereof should not be limited tostructures or methods capable of achieving these objectives.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS

Other objects, features and advantages will occur to those skilled inthe art from the following description of a preferred embodiment and theaccompanying drawings, in which:

FIG. 1 is a schematic block diagram showing the primary components ofone embodiment of the system and method to electronically coordinate anddocument patient care regardless of physical setting;

FIG. 2 is a schematic block diagram showing an example of the end usercomputing device shown in FIG. 1 capturing patient identificationinformation and critical healthcare information from an electronicpersonal identification device located on a patient;

FIG. 3 is a schematic diagram showing an example of the wearablesubsystem shown in FIG. 1 configured as an adhesive patch;

FIG. 4 is a schematic diagram showing in further detail the flexibleprinted circuit board shown in FIG. 3;

FIGS. 5A and 5B are schematic block diagrams showing in further detailthe one example of the structure of the plurality of flexible layers ofthe adhesive patch shown in FIG. 3;

FIG. 5C is a bottom view of the adhesive patch shown in FIGS. 5A and 5Bwhen the bottom adhesive layer shown in FIG. 5B is transparent;

FIG. 6 shows examples of the wearable patch subsystem shown in one ormore of FIGS. 1-5 located on easily accessible areas of the patient;

FIG. 7 is a schematic diagram showing an example of the flexible printedcircuit board shown in one or more of FIGS. 3-5 using a supercapacitoras the power source for the power supply;

FIG. 8 is a circuit diagram showing in further detail the primarycomponents of the wearable subsystem shown in one or more of FIGS. 1-7;and

FIG. 9 is a block diagram showing one example of the primary steps ofone example of the method for electronically coordinating anddocumenting patient care regardless of physical setting.

DETAILED DESCRIPTION OF THE INVENTION

Aside from the preferred embodiment or embodiments disclosed below, thisinvention is capable of other embodiments and of being practiced orbeing carried out in various ways. Thus, it is to be understood that theinvention is not limited in its application to the details ofconstruction and the arrangements of components set forth in thefollowing description or illustrated in the drawings. If only oneembodiment is described herein, the claims hereof are not to be limitedto that embodiment. Moreover, the claims hereof are not to be readrestrictively unless there is clear and convincing evidence manifestinga certain exclusion, restriction, or disclaimer.

There is shown in FIG. 1 one example of system 10 to electronicallycoordinate and document patient care regardless of physical setting.System 10 includes wearable subsystem 12, shown in greater detail incaption 18, attached to patient 14 at point of injury 16. Patient 14 maybe an armed forces soldier or other military personnel injured tit pointof injury 16 in a combat situation or a civilian injured at a point ofinjury. Wearable subsystem 12 remains attached to patient 14 from pointof injury 16 and during one or more encounters of patient 14 withmedical personnel or to a time patient 14 reaches a clinical hospitalfacility, e.g., combat hospital 22 or similar type clinical carefacility. The medical care provided to patient 14 by medical personalmay be at point of injury 16 and/or during the one or more encounterswith medical personnel, e.g., during basic primary care 20 which mayinclude, inter alia, interventions for broken bones, medicationsadministered, field intubation, or any other medical procedure,intervention, and the like, provided to patient 14 by medical personnel.

Wearable subsystem 12 is preferably easily maintained through multiplepatient handoffs, e.g., from point of injury 16, evac to basic primarycare 20, and transport to clinical care facility 22. Because aconventional patch is often used by medical personnel and non-medicalpersonnel, little training is required for applying wearable subsystem12 to an injured patient, as discussed below.

Wearable subsystem 12 stores patient identification information andcritical healthcare information received via wireless communication,indicated at 24, from end user computing device 26 at point of injury16, as discussed in detail below. Wearable subsystem 12 also storeshealthcare information added by medical personnel to end user computingdevice 26 from or at point of injury 16 and during one or moreencounters with medical personnel received via wireless communication,indicated at 54, from end user computing device 26.

Wearable subsystem 12 of system 10 may also be referred to herein asPersistent Access to Tactical Casualty Health (PATCH) subsystem 12.Wearable or PATCH subsystem 12 is preferably a high capacity device thatis designed for efficient and rapid two-way communication between theend user computing device 26 and wearable or PATCH subsystem 12. Thehealth care information regarding care provided to patient 14 may bealtered, amended, and/or added to by end user computing device 26 toinclude care provided to patient 14 during or at point of injury 16and/or during one or more encounter with medical personnel. The updatedinformation regarding the care provided to patient 14 is preferablytransferred, or downloaded, via wireless communication from end usercomputing device 26 to wearable or PATCH subsystem 12.

End user computing device 26 is preferably a smart device, e.g., asmartphone, a cellular phone, a tablet, a PDA, or similar type smartdevice that includes one or more processors, an electronic storagedevice or memory, and preferably includes one or more casualty careprograms, e.g., an electronic Tactical Combat Casualty Care Program(TCCC), electronic Patient Care Reporting (ePCR) subsystem, or similartype programs preferably configured to input and/or receive and storethe patient identification information and critical health careinformation of patient 14 at point of injury 16 and the added healthcare information provided by medical personnel from or at point ofinjury 16 and during one or more encounters with the medical personnelor to a time patient 14 reaches a clinical care facility.

End user computing device 26 may communicate with wearable subsystem 12by conventional wireless technology without using cables or wires. Inother examples, e.g., when conventional long-distance wirelesscommunication is not available or at other times, end user computingdevice 26 may communicate with wearable subsystem 12 using short-rangecommunication, e.g., near-field communication (NFC) or similar typenear-field communication subsystem which may employ inductive coupling,optical coupling, acoustic coupling, radio-frequency coupling, orsimilar type coupling methods. Preferably, the near Held communicationemploys industry-standard coupling and communications protocols. Such adesign provides the ability for wearable subsystem 12 to efficientlyoperate regardless of the state of long distance communication.Preferably NFC can transfer data in any digital format, preferably adigital format that is self-delimited (e.g., includes headers, trailers,and other structures to avoid reading a partial data set) that can beread by computer subsystem, smart device, or similar type device andimported to an Electronic Medical Record or more generally, anElectronic Health Record (EHR), e.g., EHR 44, discussed below.Preferably the health care information regarding the care provided topatient 14 stored on wearable or PATCH subsystem 12 and the patientidentifying information and critical health information can be accessedby the same medical personnel at the point of injury 16 and during oneor more encounters with medical personnel using end user computingdevice 16. The health care information regarding the care provided topatient 14 stored to wearable or PATCH subsystem 12 as well as thepatient identifying information and critical health information can bealso be easily accessed by the next medical personnel caring for thepatient, e.g., basic primary care 20 using end user computing device 26.Thus, the health care information regarding the care provided to patient14 and the patient identifying information and critical healthinformation stored on wearable or PATCH subsystem 12 follows patient 14from point of injury 16, during one or more encounters with medicalpersonnel, or to a time patient 14 reaches a clinical care facility. Inone example, once patient 14 reaches the clinical care facility,wearable subsystem 12 preferably transfers via wireless communicationthe patient identification information and critical care healthcareinformation and the healthcare information added by medical personnelduring one or or more encounters with medical personnel to EHR 44associated with a computer subsystem or an electronic storage device ofthe clinical care facility. In one example, system 10 may utilize reader88, e.g., a dongle or similar type device, that may wirelessly transferhealth care information provided to patient 14 by medical personnel andthe patient identification information and critical healthcareinformation from wearable subsystem 12 to EHR 44 associated with acomputer subsystem at the clinical care facility.

In one example, end user computing device 26 preferably raptures viawireless communication the patient identification information and thecritical health care information of patient 14 at point of injury 16from electronic personal identification device 42, FIG. 2, e.g., anelectronic medical bracelet, an electronic dog tag, an electronic dogtag silencer, an electronic medical necklace, an NFC device, or similartype device already located on a patient 14 at a point of injury 16. Inthis example, new patient 14 is preferably first added to the one ormore casualty care programs residing in end user computing device 26,indicated at 32, and the patient identification information and thecritical health care information is preferably captured by end usercomputing device 26 using wireless communication, indicated at 40, fromelectronic personal identification device 42. In one design, end usercomputing device 26 may communicate with electronic personalidentification device 42 by conventional wireless technology withoutusing cables or wires. In other examples, e.g., when conventional longdistance wireless communication is not available or at other times, enduser computing device 26 may communicate with electronic personalidentification device 42 using short range communication, e.g., NFC orother similar short range communication system and methods, such asUltra-wideband, Bluetooth, and the like, which can both be preferablyenabled by a NFC connection. Preferably the NFC device activates whenend user computing device 26 is brought near electronic personalidentification device 42 and transfers information necessary toautomatically initiate another short range communication connectionusing a communications subsystem which may preferably have the abilityto transfer larger quantities of information at faster speeds. In oneexample, the patient identifying information and critical healthinformation stored on personal electronic storage device 42 may betransmitted to end user computing device 16 via NFC by touching (orbringing very near) end user computing device 16 to personal electronicstorage device 42. In this example, no long distance wirelesscommunication, e.g., LTE, 3G, 4G, 5G, and the like, is required. Thepatient identifying information and critical health information storedon personal electronic storage device 42 preferably automaticallypopulates the one or more of the casualty care programs or apps locatedon end user computing device 26 and additional information may be addedas needed.

In one design, wearable subsystem 12 FIG. 1, may be configured as anadhesive patch which easily attaches to skin 60 of patient 14. FIG. 3shows one example of wearable subsystem 12 configured as adhesive patch50. Adhesive patch 50 preferably includes flexible printed circuit board52, shown in greater detail in FIG. 4. Flexible printed circuit board 52preferably includes one or more processing subsystems 62, electronicstorage device 64, firmware, NFC Transceiver 100 and power supply 66with connected power source 67. Processing subsystem 62 may include oneor more processors, an application-specific integrated circuit (ASIC),firmware, hardware, and/or software (including firmware, residentsoftware, micro-code, and the like) or a combination of both hardwareand programs that may all generally be referred to herein as a“processing subsystem”, which may be part of system 10 and methodthereof. Electronic storage device 64 may include any combination ofcomputer-readable media or memory. The computer-readable media or memorymay be a computer-readable signal medium or a computer-readable storagemedium. The computer-readable storage medium or memory may beelectronic, magnetic, optical, electromagnetic, infrared, asemiconductor subsystem, apparatus, or device, or any suitablecombination of the foregoing. Other examples of electronic storagedevice 64 may include an electrical connection having one or more wires,random access memory (RAM), read-only memory (ROM), erasableprogrammable read-only memory (EPROM or Flash memory), an optical fiber,an optical storage device, a magnetic storage device, or any suitablecombination of the foregoing. As disclosed herein, electronic storagedevice 64 may be any tangible medium that can contain, or store one ormore programs for use by or in connection with one or more processors onflexible printed circuit board 52. Processing subsystem 62, electronicstorage device 64, and NFC transceiver 100 may be implemented in asingle ASIC or as a combination of integrated circuits each implementingone of more or the subsystem functions.

Computer program code for the one or more programs for carrying out theinstructions or operation of one or more embodiments wearable subsystem12 may be written in any combination of one or more programminglanguages, including an object oriented programming language, e.g., C++,Smalltalk, Java, and the like, and conventional procedural programminglanguages, such as the “C” programming language, Assembly language orsimilar programming languages.

One of more embodiments of wearable subsystem 12 of system 10 and themethod thereof disclosed below with reference to flowchart illustrationsand/or block diagrams of systems and methods are possible. Each block ofthe flowchart illustrations and/or block diagrams, and combinationsthereof may be implemented by computer program instructions. Thesecomputer program instructions may be provided to the processingsubsystem or other programmable data processing apparatus to produce amachine, such that the instructions, which execute by the processingsubsystem create means for implementing the functions/acts specified inthe flowchart and/or block diagram block or blocks.

Adhesive patch 50, FIG. 3, preferably includes a plurality of flexiblelayers 54, 56 about flexible printed circuit board 52 which preferablysandwich flexible printed circuit board 52 as shown. FIG. 5A shows infurther detail top one example of the structure of flexible top layer54. FIG. 5B shows in further detail one example of the structure offlexible bottom layer 56 and flexible printed circuit board 52 disposedthereon.

Adhesive patch 50 of wearable subsystem 12, as in caption 18, preferablyattaches to skin 60, FIG. 1, of patient 14 at point of in jury 16 andremains attached to patient 14 from point of injury 16 and during one ormore encounters of patient 14 with medical personal or to a time patient14 reaches a clinical care facility. In one example, adhesive patch 50preferably includes adhesive cover layer 58, FIGS. 3 and 5B withadhesive 59 disposed thereon such that adhesive cover layer 58 may bepeeled off to expose adhesive 59 which attaches adhesive patch 50 toskin 60, FIG. 1, of patient 14. In one example the adhesive provided byadhesive 59 of adhesive cover layer 58, FIGS. 3 and 5B, may be e.g.,FLX054516 2378SL DLC-503-PT (FLEXcon®, Spencer, Mass.). FIG. 5C is abottom view of adhesive patch 50 shown in FIGS. 5A and 5B showing infurther detail adhesive cover layer 58 which may be peeled off to exposeadhesive 59 such that adhesive patch 50 of one embodiment of wearablesubsystem 12 may be attached to skin 60, FIG. 1, of patient 14. In FIG.5C adhesive cover layer 58 and adhesive 59 are shown as transparent sothat the bottom side of flexible printed circuit board 52 is visible.

FIG. 6 shows in further detail examples of adhesive patch 50 of wearablesubsystem 12 which is preferably attached to an easily accessible areaof patient 14, e.g., the back of the hand, indicated at 68, the forearm,indicated at 70, the bicep, indicated at 72, the deltoid, indicated at74, the clavicle, indicated at 74, or any other easily accessible areaof patient 14.

In one design, one or more or both of flexible layers 54, 56, FIGS. 3,5A, and 5B, may be configured to increase moisture vapor transmissionrate from the skin of the patient to provide for increased breathabilityand/or attachability of adhesive patch 50 of wearable subsystem 12 tothe skin of the patient. In one example, flexible top layer 54 may bemade of Derma Flex P.E.F. 32 while H-566 90 foam and flexible bottomlayer 56 may be made of FLX054516 2378SL DLC-503-PT, e.g., availablefrom FLEXcon, Spencer, Mass., which each may preferably increasemoisture vapor transmission rate from the skin of the patient to providefor increased breathability and attachability of adhesive patch 50 tothe skin of patient 14. In another example, flexible printed circuitboard 52, FIG. 5B, may include one or more openings, e.g., openings 80,which preferably increase the moisture vapor transmission rate from theskin of the patient to provide for increased breathability of adhesivepatch 50. In yet another example, flexible printed circuit board 52 mayinclude a breathable substrate configured increase the moisture vaportransmission rate from the skin of the patient to provide for increasedbreathability of adhesive patch 50.

Wearable subsystem 12 and adhesive patch 50 shown in one or more ofFIGS. 1-6 preferably has a small area, e.g., less than about 35 cm². Oneexample of a prototype of wearable subsystem 12 configured as adhesivepatch 50 includes flexible layer 54, FIG. 5A, having a length, l-90, ofabout 6.35 cm and a width, w-92 of about 4.6 cm and flexible layer 56,FIG. 5B, having a length, l-94, of about 5.10 cm and a width, w-96 ofabout 3.30 cm.

In one design, power supply 66, FIG. 4, is preferably configured aspower conditioning circuitry or subsystem on flexible printed circuitboard 52 and may use a small sized battery, e.g., a CR1225 battery(Exell Battery, North Las Vegas, Nev.) for power source 67, which inthis example may be inserted into battery holder 76 and preferablyprovides power to wearable subsystem 12 for an extended period of time,e.g., about 3,200 hours, or similar extended period of time. In anotherdesign, power supply 66 may use a supercapacitor, e.g., supercapacitor98. FIG. 7, for power source 67, which preferably provides power tosystem 10 for an extended period of time, e.g. about 2,000 hours orsimilar extended period of time.

FIG. 8 is a circuit diagram showing in further detail one example of theprimary components of flexible printed circuit board 52 of wearablesubsystem 12 and adhesive patch 50 shown in one or more of FIGS. 1-7including, inter alia, processing subsystem 62, electronic storagedevice 64, power supply 66, and also showing an example of NFCtransceiver 100, and connector 102.

One example of the method for electronically coordinating anddocumenting patient care regardless of physical setting includesattaching a wearable subsystem to a patient at a point of injury, thewearable subsystem configured to remain attached to tire patient at thepoint of injury and during one or more encounters with medical personnelor to a time the patient reaches a clinical care facility, step 150,FIG. 9. The method also includes storing patient identificationinformation and critical care health care information received viawireless communication from an end user computing device at the point ofinjury on the wearable subsystem and storing added healthcareinformation provided by the medical personnel from or at the point ofinjury and during one or more encounters with medical personnel or to atime the patient reaches the clinical care facility, step 152.

The result is wearable subsystem 12 of system 10 and the method thereoffor electronically coordinating and documenting patient care regardlessof physical setting is preferably easily maintained through multiplepatient handoffs to various medical personnel and efficiently andeffectively stores patient identification information and criticalhealth care information and health care information provided by medicalpersonnel from or at the point of injury and during one or moreencounters by medical personnel or to a time the patient reaches aclinical care facility. Because wearable subsystem 12 may be configuredas an adhesive patch, it can be easily attached to the patient 14 andrequires little training to use. The unique structure of wearablesubsystem configured as an adhesive patch provides for increasedmoisture vapor transmission which increases the breathability and/orattachability of the adhesive patch. The wearable subsystem preferablyhas a small area and can easily be placed on any exposed area of theskin of the patient away from the injury.

Although specific features of the invention are shown in some drawingsand not in others, this is for convenience only as each feature may becombined with any or all of the other features in accordance with theinvention. The words “including”, “comprising”, “having”, and “with” asused herein are to be interpreted broadly and comprehensively and arenot limited to any physical interconnection. Moreover, any embodimentsdisclosed in the subject application are not to be taken as the onlypossible embodiments.

In addition, any amendment presented during the prosecution of thepatent application for this patent is not a disclaimer of any claimelement presented in the application as filed: those skilled in the artcannot reasonably be expected to draft a claim that would literallyencompass all possible equivalents, many equivalents will beunforeseeable at the time of the amendment and are beyond a fairinterpretation of what is to be surrendered (if anything), the rationaleunderlying the amendment may bear no more than a tangential relation tomany equivalents, and/or there are many other reasons the applicantcannot be expected to describe certain insubstantial substitutes for anyclaim element amended.

Other embodiments will occur to those skilled in the art and are withinthe following claims.

What is claimed is:
 1. A system to electronically coordinate anddocument patient care regardless of physical setting, the systemcomprising: a wearable subsystem attached to a patient, the wearablesubsystem configured to store patient identification information andcritical health care information added by medical personnel via an enduser computing device and transfer the patient identificationinformation and critical health care information to the wearablesubsystem via direct wireless communication between an end usercomputing device and the wearable patch subsystem and configured tostore added health care information provided by medical personnel via anend user computing device and transfer the added health care informationprovided by medical personnel via direct wireless communication betweenan end user computing device and the wearable patch subsystem.
 2. Thesystem of claim 1 in which the wearable subsystem is configured as anadhesive patch.
 3. The system of claim 2 in which the adhesive patchincludes a flexible printed circuit board.
 4. The system of claim 3 inwhich the flexible printed circuit board includes one or more of: aprocessing subsystem, an electronic storage device, firmware, and apower supply.
 5. The system of claim 3 in which the adhesive patchincludes a plurality of flexible layers about the flexible printedboard.
 6. The system of claim 5 in which one of the plurality offlexible layers includes an adhesive layer configured to attach to theskin of the patient.
 7. The system of claim 6 in which one or more ofthe plurality of flexible layers are configured to increase moisturevapor transmission rate of vapor from skin of the patient to provideincreased breathability and attachability of the adhesive patchsubsystem to the skin.
 8. The system of claim 3 in which flexibleprinted circuit board includes a breathable substrate configured toincrease moisture vapor transmission rate of vapor from skin of thepatient to provide increased breathability.
 9. The system of claim 3 inwhich the flexible printed circuit board includes a plurality ofopenings configured to increase moisture vapor transmission rate ofvapor from skin of the patient to provide increased breathability. 10.The system of claim 1 in which the wearable subsystem has a small area.11. The system of claim 10 in which the small area is less than about 35cm².
 12. The system of claim 4 in which the power supply includes abattery configured to provide power for an extended period of time. 13.The system of claim 4 in which the power supply includes asupercapacitor configured to provide power for an extended period oftime.
 14. The system of claim 2 in which the wear able subsystem isattached to an easily accessible area of the patient.
 15. The system ofclaim 1 in which the wearable subsystem is configured to transfer thepatient identification information and critical health care informationand the health care information added by the medical personnel to anelectronic medical record or electronic health record.
 16. The system ofclaim 1 in which the wearable subsystem is configured to operateregardless of a state of long distance communication.
 17. The system ofclaim 16 in which wearable subsystem is configured to operate usingshort range communication.
 18. The system of claim 1 in which the enduser computing device is configured to capture via wirelesscommunication the patient identification information and the criticalhealth care information from an electronic personal identificationdevice already located on a patient at a point of injury.
 19. The systemof claim 18 in which the end user computing device operates using shortrange communication.
 20. The system of claim 18 in which the end usercomputing device includes one or more casualty care programs configuredto input and/or receive and store the patient identification informationand critical health care information and the health care informationprovided by the medical personnel.
 21. The system of claim 20 in whichthe one or more casualty care programs include an electronic TacticalCombat Casualty Care Program (TCCC).
 22. The system of claim 21 in whichthe one or more casualty care programs include an electronic PatientCare Reporting (ePCR) subsystem.
 23. A method for electronicallycoordinating and documenting patient care regardless of physicalsetting, the method comprising: attaching a wearable subsystem to apatient, the wearable subsystem; and storing patient identificationinformation and critical care health care information added by medicalpersonnel via an end user computing device and transfer the patientidentification information and critical health care information to thewearable subsystem via direct wireless communication between an end usercomputing device and the wearable patch subsystem and storing addedhealthcare information provided by the medical personnel via an end usercomputing device and transfer the added health care information providedby medical personnel via direct wireless communication between an enduser computing device and the wearable patch subsystem.
 24. The methodof claim 23 in which wireless communication includes short rangecommunication.
 25. The method of claim 23 further including transferringthe patient identification information and critical health careinformation and health care added by medical personnel to an electronicmedical record or electronic health record.
 26. The method of claim 23further including increasing moisture transmission rate of the wearablesubsystem to provide increased breathability and attachability of thewearable subsystem to the patient.
 27. The method of claim 23 furtherincluding capturing via wireless communication the patientidentification information and critical health care information from anelectronic personal communication device already located on the patientat a point of injury.
 28. The method of claim 27 further includingcapturing via the patient identification information and critical healthcare information from an electronic personal communication devicealready located on the patient at a point of injury using short rangecommunication.